Consider the Whole Patient
December 2, 2013
What should patients and doctors do with competing health research information? The New York Times asked me to weigh in on that topic in response to new, controversial statin guidelines rolled out by the American Heart Association (AHA) and the American College of Cardiology (ACC) earlier this month. The debate about the news got me thinking about the importance of how we synthesize and interpret research and scientific evidence in the effort to transform our health care system from disease care to health and well care.
Samueli Institute has contributed its share of scientific research to that effort, much of which has been in the form of systematic reviews and meta-analyses. Some people know the phrase “systematic review” but few realize that these research methodologies are the gold standard in evidence-based medicine—ranking even higher than double-blind randomized control trials.
Systematic reviews are the highest standard of research because they synthesize a comprehensive body of research to determine the best available evidence for the effectiveness of a practice or treatment. Systematic reviews are scientific explorations in themselves. They are, as the name implies, systematic and carefully structured approaches to integrating primary sources of research. Through a series of transparent steps that can be easily replicated, experts engaged in a systematic review develop clear criteria and score existing data sets for inclusion and exclusion and quality so that the evidence can be thoroughly evaluated.
The Institute has streamlined this approach and improved on its rigor by developing careful rule books for applying this approach, automating the process to reduce errors, and carefully training any subject matter experts involved. We then go a step further and organize the evidence interpretation process by using a modified, structured, transparent Delphi process that balances and captures expert judgment in order to carefully manage the bias in any attempt to use evidence. If the AHA and ACC had used such a process, the reasons for their recommendations and uncertainty that accompanies it would be more transparent and adaptable to clinical practice and policy. We recommend that all evidence based medicine use similar approaches.
This February, Samueli Institute experts will offer a three-day course in the art and science of conducting a systematic review at a workshop hosted by the University of California San Diego (UCSD) on February 21-23, 2014. This is a unique opportunity to get hands-on training on systematic reviews, including learning how to assess the quality of studies and the management of bias and judgment.
If this topic is at all of interest to you or could benefit your own research or organization, please reserve a seat for this small workgroup now and I’ll see you in San Diego in February.
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Wayne B. Jonas, MD
President and CEO
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